Clinical characteristics and surgical outcome analysis of quadrigeminal cistern arachnoid cysts in children: a quantitative retrospective cohort study

doi:10.3969/j.issn.1674-8115.2026.01.008

Abstract

Abstract:

Objective ·To quantify the volume of quadrigeminal cistern arachnoid cysts (QACs) and hydrocephalus indicators, and analyze the clinical features of QACs in children and the efficacy of different surgical techniques, with the goal of improving understanding, diagnosis, and treatment of this condition. Methods ·A retrospective analysis was conducted on 27 pediatric patients with QACs treated at Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, between January 2015 and June 2025. The volume of QACs and the Evans index were calculated by using cranial magnetic resonance imaging (MRI) and computed tomography (CT). Clinical data, including demographics, symptoms/signs, imaging findings, surgical procedures, and follow-up outcomes, were reviewed. Results ·The cohort (age range: 0 d‒150 months; male-to-female ratio: 1.08∶1) had a median preoperative QAC volume of 34 402 (15 022, 138 478) mm³ and a median Evans index of 0.29 (0.24, 0.48). Among the cases, twelve were asymptomatic and were predominantly infants under 6 months of age, whereas fifteen symptomatic cases—presenting with intracranial hypertension, seizures, limb weakness, or frequent blinking—were mostly older than 6 months. A total of 33 surgeries were performed (one surgery: 22 cases; two surgeries: 4 cases; three surgeries: 1 case). Reoperation rates were 15.8% for endoscopic fenestration (EF), 40.0% for EF combined with endoscopic third ventriculostomy (ETV), and 0 for ventriculoperitoneal shunt (VP). The overall reoperation rate was 18.5%, with infants under 6 months having a higher probability of requiring repeat surgeries. During follow-up, 88.9% of patients showed significant QAC volume reduction at 3 months postoperatively, and 92.3% exhibited clinical improvement. No efficacy differences were found among EF, EF+ETV, and VP procedures to date. Patients with larger preoperative QACs (≥50 000 mm³) showed more pronounced reductions in QAC volume and Evans index at 12 and 24 months postoperatively. Conclusion ·QACs exhibit no gender predilection and may present with limb weakness or frequent blinking as initial symptoms. Age and symptoms may be correlated. Surgical outcomes are favorable, with low reoperation rates, significant short-term volume reduction, and symptom resolution. No difference in efficacy is observed among EF, EF+ETV, and VP procedures. Larger QACs are associated with a better long-term prognosis.

Key words: quadrigeminal cistern arachnoid cyst (QAC), quantitative analysis, clinical manifestation, surgical outcome, child

CLC Number:

R726

Liu Meiling, Bao Lei, Min Lingzhao, Wei Jia, Hua Li, Wang Xiaoqiang. Clinical characteristics and surgical outcome analysis of quadrigeminal cistern arachnoid cysts in children: a quantitative retrospective cohort study[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 66-74.

Figures/Tables 5

TrendMD

References 13

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Item	Total (n=27)	≤6 month (n=12)	>6 month (n=15)	P value
Age of diagnosis/month	0 (0, 47)	0 (0, 0)	35 (7, 112)	0.002
Age of treatment/month	12 (5, 48)	5 (3, 6)	36 (13, 112)	0.001
Gender/n(%)				1.000
Female	13 (48.1)	6 (50.0)	7 (46.7)
Male	14 (51.9)	6 (50.0)	8 (53.3)
Symptom/n(%)				0.014
Yes	15 (55.6)	3 (25.0)	12 (80.0)
No	12 (44.4)	9 (75.0)	3 (20.0)
Number of QAC/n(%)				0.745
1	14 (51.9)	6 (50.0)	8 (53.3)
2	10 (37.0)	4 (33.3)	6 (40.0)
3	3 (11.1)	2 (16.7)	1 (6.7)
Location of QAC/n(%)				1.000
Inside the quadrigeminal cistern	10 (37.0)	4 (33.3)	6 (40.0)
Outside the quadrigeminal cistern	17 (63.0)	8 (66.7)	9 (60.0)
Number of surgery/n(%)				0.010
1	22 (81.5)	7 (58.3)	15 (100.0)
2	4 (14.8)	4 (33.3)	0 (0.0)
3	1 (3.7)	1 (8.3)	0 (0.0)
Hydrocephaly/n(%)				0.363
Yes	12 (44.4)	7 (58.3)	5 (33.3)
No	15 (55.6)	5 (41.7)	10 (66.7)
Preoperative volume of QAC/n(%)				0.239
<50 000 mm³	16 (59.3)	9 (75.0)	7 (46.7)
≥50 000 mm³	11 (40.7)	3 (25.0)	8 (53.3)
Preoperative volume of QAC/mm³	34 402 (15 022, 138 478)	33 929 (15 385, 71 125)	66 260 (14 314, 146 140)	0.411
Preoperative Evans/n(%)	0.29 (0.24, 0.48)	0.30 (0.24, 0.48)	0.27 (0.24, 0.46)	0.719

Item	Total (n=27)	≤6 month (n=12)	>6 month (n=15)	P value
Age of diagnosis/month	0 (0, 47)	0 (0, 0)	35 (7, 112)	0.002
Age of treatment/month	12 (5, 48)	5 (3, 6)	36 (13, 112)	0.001
Gender/n(%)				1.000
Female	13 (48.1)	6 (50.0)	7 (46.7)
Male	14 (51.9)	6 (50.0)	8 (53.3)
Symptom/n(%)				0.014
Yes	15 (55.6)	3 (25.0)	12 (80.0)
No	12 (44.4)	9 (75.0)	3 (20.0)
Number of QAC/n(%)				0.745
1	14 (51.9)	6 (50.0)	8 (53.3)
2	10 (37.0)	4 (33.3)	6 (40.0)
3	3 (11.1)	2 (16.7)	1 (6.7)
Location of QAC/n(%)				1.000
Inside the quadrigeminal cistern	10 (37.0)	4 (33.3)	6 (40.0)
Outside the quadrigeminal cistern	17 (63.0)	8 (66.7)	9 (60.0)
Number of surgery/n(%)				0.010
1	22 (81.5)	7 (58.3)	15 (100.0)
2	4 (14.8)	4 (33.3)	0 (0.0)
3	1 (3.7)	1 (8.3)	0 (0.0)
Hydrocephaly/n(%)				0.363
Yes	12 (44.4)	7 (58.3)	5 (33.3)
No	15 (55.6)	5 (41.7)	10 (66.7)
Preoperative volume of QAC/n(%)				0.239
<50 000 mm³	16 (59.3)	9 (75.0)	7 (46.7)
≥50 000 mm³	11 (40.7)	3 (25.0)	8 (53.3)
Preoperative volume of QAC/mm³	34 402 (15 022, 138 478)	33 929 (15 385, 71 125)	66 260 (14 314, 146 140)	0.411
Preoperative Evans/n(%)	0.29 (0.24, 0.48)	0.30 (0.24, 0.48)	0.27 (0.24, 0.46)	0.719

Item	Total	EF	EF+ETV	VP	P value
Evans index change at 3 months postoperatively/n(%)					0.477
Decreased	14 (51.9)	8 (42.1)	3 (60.0)	3 (100)
Increased	9 (33.3)	7 (36.8)	2 (40.0)	0 (0)
Unchanged	4 (14.8)	4 (21.1)	0 (0)	0 (0)
Evans index change at 12 months postoperatively/n(%)					0.515
Decreased	6 (37.5)	3 (25.0)	1 (50.0)	2 (100)
Increased	7 (43.8)	6 (50.0)	1 (50.0)	0 (0)
Unchanged	3 (18.7)	3 (25.0)	0 (0)	0 (0)
Evans index change at 24 months postoperatively/n(%)					0.105
Decreased	6 (60.0)	2 (33.3)	1 (100)	3 (100)
Increased	4 (40.0)	4 (66.7)	0 (0)	0 (0)
Cyst volume change at 3 months postoperatively/n(%)					0.376
Shrunken	24 (88.9)	17 (89.5)	5 (100)	2 (66.7)
Enlarging	3 (11.1)	2 (10.5)	0 (0)	1 (33.3)
Cyst volume change at 12 months postoperatively/n(%)					0.245
Shrunken	12 (75.0)	10 (83.3)	1 (50.0)	1 (50.0)
Enlarging	4 (25.0)	2 (16.7)	1 (50.0)	1 (50.0)
Cyst volume change at 24 months postoperatively/n(%)					1.000
Shrunken	7 (70.0)	4 (66.7)	1 (100)	2 (66.7)
Enlarging	3 (30.0)	2 (33.3)	0 (0)	1 (33.3)
Postoperative complications/n(%)					1.000
Yes	7 (25.9)	5 (26.3)	1 (20.0)	1 (33.3)
No	20 (74.1)	14 (73.7)	4 (80.0)	2 (66.7)

Item	Total	EF	EF+ETV	VP	P value
Evans index change at 3 months postoperatively/n(%)					0.477
Decreased	14 (51.9)	8 (42.1)	3 (60.0)	3 (100)
Increased	9 (33.3)	7 (36.8)	2 (40.0)	0 (0)
Unchanged	4 (14.8)	4 (21.1)	0 (0)	0 (0)
Evans index change at 12 months postoperatively/n(%)					0.515
Decreased	6 (37.5)	3 (25.0)	1 (50.0)	2 (100)
Increased	7 (43.8)	6 (50.0)	1 (50.0)	0 (0)
Unchanged	3 (18.7)	3 (25.0)	0 (0)	0 (0)
Evans index change at 24 months postoperatively/n(%)					0.105
Decreased	6 (60.0)	2 (33.3)	1 (100)	3 (100)
Increased	4 (40.0)	4 (66.7)	0 (0)	0 (0)
Cyst volume change at 3 months postoperatively/n(%)					0.376
Shrunken	24 (88.9)	17 (89.5)	5 (100)	2 (66.7)
Enlarging	3 (11.1)	2 (10.5)	0 (0)	1 (33.3)
Cyst volume change at 12 months postoperatively/n(%)					0.245
Shrunken	12 (75.0)	10 (83.3)	1 (50.0)	1 (50.0)
Enlarging	4 (25.0)	2 (16.7)	1 (50.0)	1 (50.0)
Cyst volume change at 24 months postoperatively/n(%)					1.000
Shrunken	7 (70.0)	4 (66.7)	1 (100)	2 (66.7)
Enlarging	3 (30.0)	2 (33.3)	0 (0)	1 (33.3)
Postoperative complications/n(%)					1.000
Yes	7 (25.9)	5 (26.3)	1 (20.0)	1 (33.3)
No	20 (74.1)	14 (73.7)	4 (80.0)	2 (66.7)

Item	Preoperative	At 3 months postoperatively			At 12 months postoperatively			At 24 months postoperatively
Item	Preoperative	Value	t value	P value	Value	t value	P value	Value	t value	P value
Evans index	0.29 (0.24, 0.48)	0.28 (0.24, 0.44)	0.319	0.751	0.28 (0.25, 0.41)	0.459	0.649	0.33±0.09	0.422	0.677
QAC volume/mm³	33 456 (15 022, 138 478)	16 982 (9 166, 66 872)	3.580	0.001	29 020 (11 646, 63 938)	1.551	0.129	62 669±48 573	0.549	0.588
Evans index change rate	‒	0.03±0.08	1.889	0.070	0 (-0.04, 0.14)	-0.399	0.696	0.09 (-0.04, 0.26)	-0.256	0.804
QAC volume change rate	‒	0.36 (0.15, 0.50)	2.947	0.007	0.26 (-0.02, 0.60)	0.024	0.981	0.22 (-0.21, 0.31)	-0.459	0.657